(middle or central route)
frequently difficult in the injured due to need to protect c-spine.
1. Place pt supine, 15o head down
to distend neck veins and prevent air embolism. If c-spine
cleared, turn head away from venipuncture site.
2. Cleanse, drapes, sterile gloves.
3. Local anaesthetic if awake.
4. Large caliber needle attached to a 10ml syringe with 1ml saline 1cm:
insert into centre of triangle formed by 2 lower heads of SCM and
5. After skin puncture, keep bevel upward, expel skin plug that may be
occluding the needle.
6. Direct needle caudally, parallel to the sagittal plane, at 30o
posterior angle with the frontal plane.
7. Slowly advance while withdrawing the plunger of the syringe.
8. When free flow of blood occurs, rotate bevel of needle caudially,
remove syringe and occlude with finger to
prevent an air embolism. If vein not entered, withdraw and
redirect 5-10o laterally.
9. Insert guidewire while monitoring the ECG. Remove needle over
10. Insert catheter over the guidewire to a predetermined depth (tip
should be above right atrium for fluid administration).
11. Connect IV tubing and affix to skin with suture, taping tubing in
12. Get a chest film.
Arterial / neurologic injury